venous doppler characteristics kaye's class

venous doppler signal must be heard at all points

these veins typically have no spontaneous doppler signal 

tibial veins and small saphenous vein in the lower extremity

ulnar veins in the upper extremity

vessel is without obstruction

variance of flow corresponding to respiration

normal response augmentation / increase the venous signal, with no venous doppler signal immediately following the release of the distal compression

abnormal response augmentation: the absence of argumentation during distal compression is consistent with an obstruction

• Normal response: venous flow should be halted
• Abnormal response: augmentation or increase in the venous flow signal during proximal compression documents venous reflux (retrograde flow) and is an indication of incompetent valvular structure.

Normal response: there should be augmentation of the venous Doppler signal

Abnormal response: no Doppler signal following release is consistent with obstruction

caused by surrounding tissues or structures which exert enough pressure on the vessel to cause compression.

--Normal venous flow patterns are PHASIC with respirations! And…in an accredited lab you must demonstrate this.

--Should demonstrate a spontaneous signal

--Should augment with distal compression and proximal release

• Normal lower extremity veins:
• -Must be completely compressible
• -Phasic with respiratory variation

-continuous flow patterns (i.e. lacking in phasicity) are not normal, and are indicative of proximal venous obstruction

To assess the competency of the vessels the Valsalva maneuver can be used as a method to apply proximal compression to the CFV common femoral vein.

congestive heart failure or severe tricuspid insufficiency), manual compression just above the inguinal ligament should be substituted

-Due primarily to their proximity to bony structures may not be completely compressible  

-Augmentation with distal compression may be reduced or not evident in the subclavian vein and proximal axillary vein

-Phasic with respiratory variation (the waveform signal decreases with expiration and increases with inspiration)

• -increased flow velocity in volume flow
• pulsatile flow

• -no response to distal compression
• incompressible vessel

-evidence of collateral vessels

• non-compressible peripheral veins
• visible thrombus may be seen within the vein. the vein is typically dilated in comparison to its paired artery
• abnormal Doppler signals such as:

-Non-spontaneous flow in veins that SHOULD demonstrate spontaneous flow, which is indicative of DVT or extrinsic compression.

-Non-phasic flow in the common femoral, femoral, and/or popliteal veins indicate the possibility of proximal obstruction

-Venous Doppler signals should demonstrate spontaneity

-Compression of abdominal and pelvic veins is not possible. As such, care should be taken to document the normal dilatation that occurs in the IVC and iliac veins, with deep inspiration.

• Normal hepatic vein flow is characterized as:
• minimally phasic, bidirectional, or pulsatile appearing

With B-mode imaging, the walls of the hepatic vein are not clearly visible.

• Normal portal vein flow is characterized as:
• minimally phasic, almost continuous
• essentially unaffected by normal respirations in an adult patient
• -With B-mode imaging, the walls of the portal vein are hyperechoic

a pulsatile waveform may be seen in cases of congestive heart failure and or fluid overload

venous flow is phasic, changing in response to the calf muscle pump and respiration. However…. there are instances where pulsatile venous flow is expected.

veins that occur in close proximity to the heart will be pulsatile …and this is NORMAL.

It is an indication of one of the following: fluid overload (over hydration), venous system dysfunction (chronic venous insufficiency/regurgitation) or increased venous pressure such as caused by congestive heart failure or severe tricuspid valve regurgitation.